Intubation guide

ABSTRACT

An adjustably flexible guide is provided to aid in the insertion of a tubular-type device into a body duct or passage. The guide is especially suitable for use by an anesthesiologist in inserting an endotracheal tube for administering anesthetic gases in connection with respiratory care and resuscitation. The guide includes a flexible tube member with a rod member inserted therein. The rod member is slidable within the tube member, and the rod member and the tube member are firmly connected at the tip of the distal ends thereof. A handle means permits the rod member to move longitudinally within the tube member, which produces an arcuate bending of the distal end of the guide. The arcuate bending is facilitated by one or more slots provided in a portion of the surface of the tube member and in a portion of the rod member. Through manipulation of the handle, the anesthesiologist is able to selectively curve the distal end of the guide to permit its insertion in the desired duct or body passage, after which a tubular-type device, such as an endotracheal tube, is slid along the guide. The guide may be removed leaving the tubular-type device in the desired location.

United States Patent 1 Salem et a1.

[ Apr. 9, 1974 INTUBATION GUIDE [75] Inventors: M. R. Salem; Teresa M. Resce; John Ziegler, all of Chicago, 111.

[73] Assignees: Dr. M. R. Salem; T. M. Resce &

' Associates, both of Chicago, 111.

[22] Filed: Dec. 19, 1972 [21] Appl. No.: 316,467

Primary Examiner-Aldrich F. Medbery [57] ABSTRACT An adjustably flexible guide is provided to aid in the insertion of a tubular-type device into a body duct or passage. The guide is especially suitable for use by an anesthesiologist in inserting an endotracheal tube for administering anesthetic gases in connection with respiratory care and resuscitation. The guide includes a flexible tube member with a rod member inserted therein. The rod member is slidable within the tube member, and the rod member and the tube member are firmly connected at the tip of the distal ends thereof. A handle means permits the rod member to move longitudinally within the tube member. which produces an arcuate bending of the distal end of the guide. The arcuate bending is facilitated by one or more slots provided in a portion of the surface of the tube member and in a portion of the rod member. Through manipulation of the handle, the anesthesiologist is able to selectively curve the distal end of the guide to permit its insertion in the desired duct or body passage, after which a tubular-type device, such as an endotracheal tube, is slid along the guide. The guide may be removed leaving the tubular-type device in the desired location.

10 Claims, 18 Drawing Figures III IV INTUBATION GUIDE BACKGROUND OF THE INVENTION This invention relates in general to an introducer or guide useful in anesthetic practice to provide a guide, e.g., for an endotracheal tube in connection with administering anesthetic gases or respiratory care and resuscitation or for other devices inserted into body ducts or passages.

It is usual in the medical practice of administering anesthetic gases to insert a hollow tube within the respiratory ducts of the body so as to ensure an uninterrupted flow of air or oxygen during surgery or other treatment. The use of such an artificial tube helps maintain the patency of the air way, facilitates artificial ventilation and removal of secretions, and prevents aspiration or inhalation of regurgitated stomach contents. Such a tube is usually termed an endotracheal tube or a tracheal tube. Although these tubes are provided in a variety of structures and for a variety of purposes, they essentially consist of a tube of flexible material, often a flexible plastic. Such tubes are insertedby the anesthesiologist through the oral or nasal passages and into the glottis and then into the trachea. During such insertion, it is critical that the tube be inserted with minimal forceful contact of the vocal cords or other portions ofthe respiratory passages so as to minimize the possibility of direct trauma thereof.

The possibility of direct trauma is further increased when the medical practitioner is inexperienced in guiding the tube through its required path. Additional difficulties are encountered when there exists anatomical variations or abnormalities, which might require that an unusually tortuous path must be followed.

A commonly used method in attempting to overcome these difficulties of tube insertion is to shape and stiffen the endotracheal tube by means of a bendable wire stilette placed in the tube. After such a stilette is properly affixed, the shaped endotracheal tube is slid through the respiratory tract and into the larynx. U.S. Pat. No. 2,541,402 shows a wire stilette having a distal portion hinged at a single location. The use of the wire stilette, when run through the respiratory ducts, increases the possibility of direct trauma and may require the introduc'tion into the tract of a tube of a diameter that is larger than that required for medical purposes.

Another technique involves the threading of the endotracheal tube over a long-gum-elastic catheter, the tip of which can be passed through the vocal cords into the trachea while the vocal cords are under direct visual observation. Once the catheter is in position, the tube under this prior art practice is moved along the catheter into position, and the catheter is withdrawn. Where direct vision is impossible due to the presence of an abnormality or an injury, the advantage of this catheter system is greatly lessened and the possibility of trauma to the vocal cords or other tissues is greatly increased.

A prior art variation of the catheter procedure is to manually curve the catheter guide before it is introduced into the respiratory opening. This has the obvious disadvantage of being a trial and error method, which often requires numerous insertions and removals from the respiratory ducts and can often result in a direct trauma, even though carefully used.

The problems encountered in these prior art devices can be reduced to a minimum by the present invention,

which provides a guide, the distal end of which may be mechanically .flexed either anteriorly or posteriorly while the guide is within the respiratory tract. The problems discussed above relative to endotracheal tube insertion are similar to those encountered in attempting to introduce other tubes or probes into a body duct or passage.

SUMMARY OF THE INVENTION The present invention consists of a tube member and a rod member made of a flexible material, as for example a plastic. The rod member, which is slidably in serted within the tube member, is rigidly secured to the distal end of the tube member. Through a control means in the form of a handle, the rod member may be guided back and forth within the tube member. Properly placed slots or cut-outs along only one side of the distal portion of each of the rod and tube members permit anterior and posterior arcuate flexing of the distal end of the guide, or introducer.

The cut-outs or slots so formed result in the tube member being unable to sustain longitudinal compressive and tensile forces along the slotted side thereof. The slotted or cut-out rod member likewise will be unable to sustain longitudinal compressive and tensile forces along the slotted side thereof, which side is disposed opposite to the slotted side of the tube member within which the rod member is slidably inserted. As a result, when the control means is manipulated so that the rod member slides back with respect to the tube member, the distal end of the introducer is arced in one direction. When the rod member is slid forwardly within the tube member, the distal end of the introducer is arced within approximately the same plane, but in the opposite general direction. As a result, the tip of the guide may be displaced in both directions through angles up to and exceeding with respect to the rest of the guide. Thus, the tip of the distal end may be directed between two extreme positions that are at least apart.

When the introducer is completely rotated about its longitudinal axis, the plane within which the tip of the distal end travels may be varied through a full 360. Hence, the tip may be mechanically maneuvered while the introducer is within the respiratory tract to a point anywhere along the surface of a hemisphere. This provides a controllable maneuverability of the introducer that greatly lessens the possibility of direct trauma to the vocal cords or other tissues of normally formed respiratory tracts displaying normal anatomical variations and is especially advantageous in providing guidance through respiratory tracts that are abnormally formed or injured.

In most cases of difficult intubation, the major problems arise in directing the endotracheal tube in the larynx. The technique of the present invention is as follows. The operator first threads the introducer through the endotracheal tube to be inserted, so that the distal end of the introducer protrudes from the tube. The operator then exposes the patients larynx by means of a laryngoscope held in one hand, and with the other hand he passes the introducer into the patients larynx, using the control handle to flex the tip. The endotracheal tube is then pushed down gently over the introducer into the trachea and the introducer withdrawn.

Once the guide of the present invention is positioned as desired, any one of a variety of standard endotracheal tubes may be slid therealong to ensure proper positioning thereof. Once the tube is in place, the guide or introducer is removed.

Due to the great flexibility provided by this invention, it may be utilized as a guide for tubes other than endotracheal tubes, for example, endobronchial tubes, body probes, or tubular-like devices for administering pharmaceuticals within the respiratory tract.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is an enlarged, partially cut away, longitudinal plan view showing a typical arrangement of the invention, including an exemplary control means.

FIG. 2 is a longitudinal section of FIG. 1 taken along the vertical diameter of FIG. 1.

FIG. 3 is a section along the line lIIlII of FIG. 1.

FIG. 4 is a section along the line IV-IV of FIG. 1.

FIG. 5 is a section along the line VV of FIG. 1. FIG. 6 is a section along the line VIVI of FIG. 1.

FIG. 7 is an enlarged longitudinal front plan view, partially broken away, of another embodiment of the invention from which the control means has been omitted.

FIG. 8 is a section along the line VIII-VIII of FIG. 7.

FIG. 9 is a section along the line IX-IX of FIG. 7.

FIG. 10 is a section along the line X-X of FIG. 7.

FIG. 11 is a longitudinal cross-section of FIG. 7 taken along the vertical diameter of FIG. 7.

FIG. 12 is an enlarged, partially cut away longitudinal plan view of the invention, which illustrates the substantially arcuate adjustable flexibility thereof.

FIG. 13 is a section along line XIII-XIII of FIG. 12.

FIG. 14 is a section along line XIV-XIV of FIG. 12.

FIG. 15 is a section along line XVXV of FIG. 12.

FIG. 16 is an enlarged, partially cut away, longitudinal sectional view showing a further embodiment of the invention which is especially suitable for use with a.

DETAILED DESCRIPTION OF THE INVENTION In FIG. 1 there is shown a typical arrangement of the introducer, generally designated as 11. Within the tube member 12 there is slidably inserted the rod member 13. To the proximal end of the introducer 11 there is attached control means 14, including stationary gripping means 15 and slidable gripping means 16. The precise structure of control means 14 shown in FIG. 1 is not essential to the invention. The control means 14 shown therein is intended to be illustrative of a structure that permits comfortable manipulation by the fingers and thumb of one hand so as to provide slidable movement.

One or more peripheral slots 17 are provided along the distal portion of the tube member 12. Each slot 17 is disposed in approximately the same radial position as any other slot of the tube member 12. The slots 17 are of a predetermined length within tube member 12.

All of slots 17 are cut into the lower portion of the distal end of the tube member 12 as it appears in FIG. 1. This arrangement of slots 17 functions to minimize the longitudinal strength along such lower portion of the distal portion. Consequently, any longitudinal compressive and tensile forces imparted to tube member 12 must be borne by the upper, unbroken longitudinal side of the distal portion.

In the embodiment best shown in FIG. 2, the distal portion of tube member 12 includes a solid portion 21. The inner surface of the tube member 12 is not circular, as is the remainder of the member 12, but it is roughly semicircular in cross section, with the solid portion 21 thereof being disposed opposite the slotted portion of the periphery of the tube member 12. This tube formation is intended to accommodate a single large slot 22 at the distal portion of rod member 13, which large slot 22 results in the cross section of the rod member being roughly semi-circular. There is provided between solid portion 21 and slot 22 a spacing 23 that will permit a preselected extent of longitudinal movement of the rod member 13 toward the distal end of the tube member 12 so that such movement will not be prevented by the contact of the edge 24 of the solid section 21 with the edge 25 of the slot 22.

As depicted in FIG. 2, large slot 22 is positioned along the upper portion of rod member 13. As a result, most longitudinal compressive and tensile forces applied to rod member 13 are sustained along the lower, unbroken side thereof. The unbroken side of the distal portion of rod member 13 is diametrically opposite the unbroken, upper side of tube member 12.

At the distal tip of the introducer 11 there is provided a fastening means 26 which firmly connects the distal tip of rod member 13 to the distal tip of tube member 12. Fastening means 27 securely connects the proximal end of tube member 12 with the stationary element 15 of control means 14. Fastening means 28 securely joins the proximal end of rod member 13 with the slidable portion 16 of control means 14. Fastening means 26, 27 or 28 may each be comprised of one or more pins, or of a suitable cement, or both, or through a variety of conventional fastening means that are suitable for joining plastic members.

FIG. 3 illustrates in cross-section the longitudinal complementary relationship of the slot 22 with the solid section 21. The clearance between rod member 13 and tube member 12 is such as to permit unencumbered longitudinal relative movement thereof.

FIG. 4 is a cross-section through one of the slots 17 which is disposed in the lower portion of the tube member 12. This Figure illustrates that the lower, unbroken portion of rod member 13 is opposite the upper, unbroken portion of tube member 12.

FIG. 5 illustrates that throughout the proximal portion of the introducer 11, the tube member has an uninterrupted hollow cross-section. FIG. 5 also depicts that rod member 13 has a solid circular cross-section throughout the proximal portion thereof. This crosssection, however, need not be solid. It may, for example, instead be hollow.

FIG. 6 is a cross-section through a typical control means. This Figure illustrates that slidable member 16 has a structure complementary with longitudinal groove 31 within stationary element 15. Slidable member 16 may be moved back and forth within groove 31.

The operator of introducer ll grasps control means 14. An exemplary grasp of the type of handle depicted in the Figures would have the operator placing his fingers along the stationary members and his thumb against slidable member 16. When the slidable member 16 is pushed forward, a compressive force is imparted to the lower side of the distal portion of rod member 13. This force is transferred, through the attachment means 26, to the distal portion of tube member 12. This thus transferred tensile force is borne primarily by the upper, unbroken portion of tube member 12. This combination of compressive force on the lower side of the rod member 13 and of the tensile force on the upper side of the tube member 12, results in the distal portion of the introducer 11 being upwardly in a relatively circular arc.

When the slidable member 16 is pulled or retracted, the tensile force imparted to the rod member 13 is similarly transferred through the attachment means 26 to the tube member 12, with the ultimate result being that the distal portion of the introducer 11 is bent downwardly so that said distal end forms a substantially circular arc.

FIG. 7 illustrates an embodiment of the invention that is particularly suitable for inexpensive commercial production of the introducer 111 in accordance with the present invention. The control means has not been shown in this Figure. The control means of this embodiment is in accordance with the type of control means shown in FIGS. 1, 3 and 6, which performs the function required of this invention as previously described.

In the embodiment shown in FIG. 7, although the mechanical principal of directing the longitudinal tensile and compressive forces previously described is the same, the structure of the distal portion of the introducer 111 is modified. The broken away section of FIG. 7, in which a portion of tube member 112 has been'removed, depicts rod member 113 as having a plurality of slots 122, rather than the single, large slot 22 depicted in FIG. 2. In addition, tube member 122 is uniformlyhollow throughout and does not contain a solid portion such as section 21 shown in FIG. 2. In place of section 21 there are provided projections 121 from rod member 113. As can be best seen in FIG. 8, projections 121 are circular in cross-section and are continuous with and identical to the structure of the proximal portion of rod member 113, best shown in FIG. 10. FIG. 9 illustrates that the slot members 117 that are formed within tube member 112 appear on the lower side of the distal portion of said tube member 112, and that the slots 122 are in the opposite, upper side of the distal portion of the rod member 113.

FIG. 11 shows fastening means 126 which joins rod member 113 to tube member 112 at their distal tips. Any manner of fastening the distal ends of the tube and rod may be used including pinning, fusing or mating of interconnecting elements. FIG. 11 also illustrates that, with a view toward obtaining maximum flexibility of the distal portion of introducer 111, it is desirable to have fewer and longer slots 112 in the rod member 113 than the number of slots 117 that are disposed in the tube 112. Also with a view toward obtaining maximum flexibility and the formation of a distal portion that will form an are that is substantially circular, the slot 141 that is farthest away from the distal tip, may be smaller than the rest of the slots 117. Slot 141 helps to ensure that the distal portion will not form a sharp angle with the proximal portion of the introducer 1 11 as the distal portion is flexed. This arrangement helps to prevent kinking which could cause injury or direct trauma to the body duct or passage.

FIG. 12 more explicitly illustrates that when the slidable member 216, rigidly connected to rod member 213, is pushed forward with respect to stationary element 215, which is rigidly connected to tube member 212, the distal portion of introducer 211 is directed to form a relatively circular arc in one direction, or .upwardly. When the slidable member 216 is pulled or retracted, the distal portion is directed to form a relatively circular arc in the opposite direction, or downwardly.

FIGS. 13, 14 and 15 illustrate that the rod member 213 may be of solid cross-section with one or more slots 222 therein.

FIG. 16 illustrates the embodiment wherein tube member 312 is hollow throughout and is open at the distal tip thereof. Similarly rod member 313 is hollow throughout and isopen at the distal tip thereof. Thus, there is provided a passageway 351 within and throughout the length of the introducer. Through passageway 351 there may be inserted a probe or other tubular like device designed for introduction into a body duct or passage.

FIG. 17 illustrates an exemplary structure whereby the extreme distal portion of the introducer has a degree of curvature greater than that of the remainder of the distal portion. This result is achieved by enlarging the depth and lateral length of extreme distal slots 457 in the tube member 412 and by decreasing the depth and lateral length of the remaining distal slots 458. The effect is also enhanced in that extreme distal slots 457 are more closely spaced than are the remaining distal slots 458. FIG. 18 illustrates an exemplary structure whereby the distal portion of the introducer can be directed into an S-shape. This shape can be accomplished by providing approximately one half of the slots 561 in the tube member 512 on the lower portion thereof and the rest of the slots 562 in the upper portion thereof. The rod member 513 is constructed so that slots 571 therein are disposed opposite slots 561 in tube member 512 and so that slots 572 therein are disposed opposite slots 562 in tube member 512.

It is within the spirit and scope of this invention that the tube member and rod member need not be of substantially circular cross section, the cross sections being readily adaptable to use with a variety of tubes for insertion into a body duct or passage.

The introducer of the present invention thus provides an extremely flexible and smoothly curved means for inserting through body ducts and delicate organs a guide that is capable of arcuate adjustment of varying degrees while within the body.

What I claim is:

1. An adjustably flexible intubation guide for assisting in the introduction of a tubular device into a body passage, comprising:

a tube member;

a rod member slidably disposed within and longitudinally movable with respect to the tube member;

a fastening means firmly joining the distal tips of the tube member and rod member;

a handle means slidably joining the proximal ends of the tube member and rod member;

at least one slot peripherally disposed in the distal portion of the tube member; and

at least one oppositely disposed slot in the distal portion of the rod member.

2. The intubation guide as claimed in claim 1, wherein said proximal portion of the tube member is of hollow cross section, and said distal portion of the tube member is of partially hollow cross section; and

said rod member is of solid cross section.

3. The intubation guide as claimed in claim 2, wherein said slot of the rod member extends for substantially the entire length of the distal portion thereof.

4. The intubation guide as claimed in claim 1, wherein said tube member is of hollow cross section; and said rod member is of solid cross section.

5. The intubation guide as claimed in claim 1, wherein said tube member is of hollow cross section; and said rod member is of hollow cross section.

6. The intubation guide as claimed in claim 1, wherein said handle means comprises a stationary element connected to said tube member and a longitudinally slidable member connected to said rod member, whereby the distal portion of said guide is curved in a substantially arcuate upward direction as said slidable member is pushed toward the distal end, and whereby the distal portiln of said guide is bent in a substantially arcuate downward direction as said slidable member is moved away from the distal end.

7. The intubation guide as claimed in claim 1, wherein said tube member has a plurality of slots, the slot nearest the proximal portion thereof being shallower than the rest of said slots.

8. The intubation guide as claimed in claim 1, wherein said tube member has a plurality of slots, the slots disposed in the extreme distal portion being larger in depth and lateral length and being more closely spaced than the slots disposed in the remainder of the distal portion.

9. The intubation guide as claimed in claim 1, wherein said tube member has a plurality of slots, first slots disposed in-the extreme distal portion being along one side thereof and second slots disposed in the remainder of the distal portion being along the opposite side thereof; and wherein said rod member has a plurality of slots, first slots disposed in the extreme distal portion thereof being along one side thereof so that said first slots of said rod member are opposite said first slots in said tube member and second slots disposed in the remainder of the distal portion of said rod member being along the opposite side thereof so that the second slots of said rod member are opposite said second slots in said tube member.

10. The intubation guide as claimed in claim 1, wherein said tube member is hollow throughout, both the distal tip and the proximal end thereof being open; and wherein said rod member is hollow throughout, both the distal tip and the proximal end thereof being open. 

1. An adjustably flexible intubation guide for assisting in the introduction of a tubular device into a body passage, comprising: a tube member; a rod member slidably disposed within and longitudinally movable with respect to the tube member; a fastening means firmly joining the distal tips of the tube member and rod member; a handle means slidably joining the proximal ends of the tube member and rod member; at least one slot peripherally disposed in the distal portion of the tube member; and at least one oppositely disposed slot in the distal portion of the rod member.
 2. The intubation guide as claimed in claim 1, wherein said proximal portion of the tube member is of hollow cross section, and said distal portion of the tube member is of partially hollow cross section; and said rod member is of solid cross section.
 3. The intubation guide as claimed in claim 2, wherein said slot of the rod member extends for substantially the entire length of the distal portion thereof.
 4. The intubation guide as claimed in claim 1, wherein said tube member is of hollow cross section; and said rod member is of solid cross section.
 5. The intubation guide as claimed in claim 1, wherein said tube member is of hollow cross section; and said rod member is of hollow cross section.
 6. The intubation guide as claimed in claim 1, wherein said handle means comprises a stationary element connected to said tube member and a longitudinally slidable member connected to said rod member, whereby the distal portion of said guide is curved in a substantially arcuate upward direction as said slidable member is pushed toward the distal end, and whereby the distal portion of said guide is bent in a substantially arcuate downward direction as said slidable member is moved away from the distal end.
 7. The intubation guide as claimed in claim 1, wherein said tube member has a plurality of slots, the slot nearest the proximal portion thereof being shallower than the rest of said slots.
 8. The intubation guide as claimed in claim 1, wherein said tube member has a plurality of slots, the slots disposed in the extreme distal portion being larger in depth and lateral length and being more closely spaced than the slots disposed in the remainder of the distal portion.
 9. The intubation guide as claimed in claim 1, wherein said tube member has a plurality of slots, first slots disposed in the extreme distal portion being along one side thereof and second slots disposed in the remainder of the distal portion being along the opposite side thereof; and wherein said rod member has a plurality of slots, first slots disposed in the extreme distal portion thereof being along one side thereof so that said first slots of said rod member are opposite said first slots in said tube member and second slots disposed in the remainder of the distal portion of said rod member being along the opposite side thereof so that the second slots of said rod member are opposite said second slots in said tube member.
 10. The intubation guide as claimed in claim 1, wherein said tube member is hollow throughout, both the distal tip and the proximal end thereof being open; and wherein said rod member is hollow throughout, both the distal tip and the proximal end thereof being open. 